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Home , Malleus Maleficarum, Mass psychogenic illness

ANALYSIS AND COMMENTARY Salem and Lessons for Contemporary Forensic

Susan Hatters Friedman, MD, and Andrew Howie, MB, ChB, BD

In 1692 and 1693, in Salem, , more than 150 colonists were accused of witchcraft, resulting in 19 being hanged and one man being crushed to death. Contributions to these events included: historical, religious and cultural systems; social and community concerns; economic, gender, and political factors; and local family grievances. Child witnessing, certainty of physician diagnosis, use of special evidence in the absence of scholarly and legal scrutiny, and tautological reasoning were important factors, as well. For forensic psychiatry, the events at Salem in 1692 still hold contemporary implications. These events of three centuries ago call to mind more recent daycare sexual abuse scandals.

J Am Acad Psychiatry Law 41:294–99, 2013

Thou shalt not suffer a to live.—Exodus 22:181 Setting the Context: Time and Place The supernatural has long fascinated the public and Attempts to understand Salem require that we psychiatrists alike. Throughout history, otherwise shed our 21st century and imagine the impossible-to-explain evils have been attributed to context of 1692 Salem. Religious, social, gender, lo- supernatural actors, such as werewolves, , cal, political, and economic factors were salient.3–5 and witches. As recognition and understanding of God and the Devil were in daily contact with the mental illness, sadism, and sociopathy have in- colonists.5,6 The Puritan church was the center of the creased, otherworldly explanations for phenomena community, spiritually and politically. “Puritans have similarly evolved. viewed the world. . .with the forces of evil engaged in Belief in possession occurs in cultures that legiti- mate the role of the Devil and see evidence of diabol- an unceasing battle for the souls of the Lord’s le- ical intervention in day-to-day events. In Biblical de- gions” (Ref. 7, p 11). Separation of fantasy from was quite different from today,8 and a belief in scriptions, Jesus Christ exorcised possession states 3 that presented similarly to , epilepsy, and witchcraft was part of the culture. We must use caution not to proceed with a self-congratulatory dissociation. Historically, women and those of lower 9 status are most likely to be considered possessed.2 stance regarding the current state of psychiatry. It is There remain cultures and subcultures that believe in necessary to focus on explanatory models available at possession, both in developing and developed na- that time in history rather than merely regarding the tions. In Pentecostal sects, two types of possession are phenomenon as a conversion reaction.10 distinguished: that flowing from the Holy Spirit and Malleus Maleficarum (translated to The Hammer approved of by society and that of diabolical origin, of Witches11), the witch-hunting manual written by which requires .2 Catholic , was used for almost two centu- ries after 1486.3 It described witchcraft as born of the Dr. Hatters Friedman is Associate Professor of Psychiatry and Pediat- carnal lust of women who were insatiable by normal rics, Case Western Reserve University School of , Cleveland, 12 OH. Dr. Howie is Clinical Director, and Drug and means. Witches were tempted by and, yielding, Alcohol Services, Far West Local Health District, Broken Hill Base entered a covenant with the Devil by signing the Hospital, Broken Hill, New South Wales, Australia. Presented at the 4,13 Royal Australian and New Zealand College of Psychiatrists’ Annual Devil’s Book. Witchcraft was therefore a crime Forensic Section Meeting in Melbourne, Australia, November 13, against God.12 Since there were no witnesses to these 2009. Address correspondence to: Susan Hatters Friedman, MD, Case Western Reserve University School of Medicine, 11100 Euclid Ave- pacts, torture was permissible in these investigations nue, Cleveland, OH 44106. E-mail: [email protected]. to gain that might otherwise be Disclosures of financial or other potential conflicts of interest: None. withheld.

294 The Journal of the American Academy of Psychiatry and the Law Friedman and Howie

The 17th century was a time of witch hunts and Rather than being reprimanded, the girls were pit- trials in Europe. In the Barragan witchcraft trials in ied and placed on center stage.6 Spanos notes, “To (1697), for example, an 11-year-old named become demonically afflicted was to adopt a social her tormentors after experiencing what appeared to role that contained fairly clear-cut expectations con- be violent seizures, losing the power of speech, and cerning the subjective experiences and behaviors re- seeing the devil in human form. Bleedings and med- quired” (Ref. 8, p 364). Symptoms spread rapidly ications had no effect. Medical evidence was pre- among girls,16 beginning diversely but becoming in- sented, leading to seven persons accused being put to creasingly consistent across victims. In fact, being 14 death. possessed oneself was the only ironclad way to pre- From 1630 to 1700 in colonial New England, in vent accusations of witchcraft. 4 total, 234 individuals were accused of witchcraft. Fasting and were not effective treatments. Salem was unique, however, because the largest witch The plan to bake a witch cake of urine from the in the colonies occurred there, even as the afflicted girls had unintended consequences. Rever- witch trials in mother England were on the decline. end Parris called in the local physician, Dr. William As women were believed to be uncontrollably lust- Griggs. Dr. Griggs ruled out epilepsy in the writhing ful creatures and children were to be seen and not agitated victims; medications were ineffective.3,5 heard, girls were relegated the lowest social status. Ergo, since illness had either natural or supernatural Salem Village, less sophisticated than Salem Town, causes,4 it was certain that the Devil and witchcraft was divided by land disputes, family rivalries, and the were causal. The girls were declared under an “evil turmoil surrounding the development of a separate hand.”3,7,16 Girls “who suffered from witchcraft, af- village church and ministerial choice. The larger pic- ter all, were the victims of a crime, not a disease” (Ref. ture also included life in a new country on a frontier, 16, p 2). (In 1695, Dr. Griggs would resurface in attacks by nearby Indians, and an unstable relation- ship with England that could cause land titles to be another forensic matter, an early testamentary capac- ity case, to testify that Mary Putnam was not of invalidated by the Crown. Natural disasters trans- 16 pired: crops failed and livestock, women, and infants sound mind when she drew up her will. ) Intense questioning of the girls15 resulted in an became diseased and died, all explained by God’s 11 will, specifically as punishment for sins.3,4,6,15 In- accusation of witchcraft against three local women. crease Mather, a prominent Puritan minister, attrib- They were among the usual suspects: poor, a slave, uted King Phillip’s War, smallpox, earthquakes, and and a woman rumored to be involved with a servant. a Boston fire to “divine displeasure for spiritual Tituba, Parris’s Caribbean slave, was accused and decline.”13 under duress named others as witches. Others who were soon accused were either not pious or were dis- liked by the community.17 Accusations grew to in- A Brief Review of Salem and Its clude not only the usual suspects, but rather promi- Witchcraft Trials nent community members as well. “The tales of In winter 1691, 11-year-old Abigail Williams, affliction spun. . .gave these young women access to niece of the Reverend Parris, began experiencing public power they had never known” (Ref. 6, p 137). symptoms of bewitchment, as did Betty Parris, his To challenge the veracity of the girls’ symptoms di- 9-year-old daughter.3,7 Soon thereafter, other girls rectly would lead to suspicion of one’s own motives. ages 9 to 17 and a woman, began experiencing symp- Indeed, Martha Corey drew attention to herself by toms, including feeling as if they were being pricked, showing scepticism about the accusations and was pinched, burned, or bitten; making odd contortions; accused and hanged. doing animal imitations; and physically and verbally The clergy had defined what physical signs indi- abusing others.4,5 Sermons were interrupted by sac- cated witchcraft, and physicians and midwives were rilegious outbursts; were flung across the directed to find them.16 A physician would deter- room. The afflicted also reported having a second mine if a disease was natural or unnatural and make a sight, seeing specters (defined as shapes of witches), diagnosis of witchcraft. “Devil’s marks” were flat or who would torment them and perpetrate evil acts raised red, blue, or brown lesions with unusual outlines, against them.4 marks identified as the Devil’s confirmation of the

Volume 41, Number 2, 2013 295 Salem Witchcraft and Lessons for Forensic Psychiatry pact.3,18 Witch’s marks were supernumerary nipples (or spent in church, many failed this test. Yet former sores) that the devil’s agents would suckle.3,4,18 Salem pastor George Burroughs recited it flawlessly Colonists faced charges of murder and spreading from the scaffold. The afflicted then claimed they disease, as well as assaultive speech.3,4 Blasphemy, in saw a black man (the Devil) nearby, dictating the theory, was a capital crime.4 The Court of Oyer and words.3 Burroughs was still executed; he had been Terminer was convened in early 1692, specifically to convicted in court, and Reverend Mather also spoke handle the witch trials.3,7 Trials were interrupted by in favor of execution.6,16,19 spasms en masse. In court, when the accused witches All told, during 1692, more than 150 Salem resi- moved, symptoms might suddenly occur. For exam- dents were accused of witchcraft. Twenty-nine were ple, if an accused bit her lip, the victims felt bitten.16 found guilty, 19 were hanged, and one crushed to This goal-directed behavior has been described as death. Forty-four people confessed to witchcraft and “socially cued symptom enactments.”8 Behavior of the four died in prison.3,5 They included not only the afflicted escalated, and fantastical stories abounded. outsiders and those with assertive personalities, but Several time-honored English rules of evidence also some models of . Simply put, there were disregarded.13,15 Spectral evidence was taken was no way to rebut the charges that one secretly tautologically as evidence that a person was a witch conspired with the devil.20 Innocent answers had and was based on the belief that the Devil cannot hidden, self-incriminating meanings,15 another ex- appear in the form of an innocent person. ample of tautology or self-incrimination based on were believed only to be able to assume the form of of the judiciary. The special court was those who had signed pacts with the Devil.3,7,19 Vic- closed by the new governor William Phipps, after tims would report seeing a vision of the accused more prominent Bostonians, including the wives of harming them, when possessed persons purposely the governor and Reverend Mather,7 were accused. projected images to torture the innocent. There was Those who were still imprisoned were pardoned. no alibi or defense against spectral evidence. Critical LaPlante explained, “While no one doubted the ex- touch or effluvia, in which an afflicted victim’s istence of witches and Satanic spirits, many ques- spasms would only end when the hands of the ac- tioned the court’s methods of determining guilt” cused were laid on them, was also used as proof of (Ref. 6, p 176). witchcraft.3,4 Another example of tautological evi- dence considered in early New England witch trials Peine Forte Et Dure was the drowning test (in which floating was used as The estate of an alleged witch who died without evidence of witchery, as water rejected evil), although entering a plea could be passed on to family, rather this test was not used in Salem.4 than surrendered to the government.3,19 Those who Debate occurred in the religious sector. Esteemed pleaded innocent might have been tortured to pro- minister Mather held the controversial view that cure a confession or put to death.7 If one admitted while spectral visions were real, could also as- guilt and named others as witches, death might be sume the shape of an innocent person.10 For fair escaped. If judges assumed that all suspects were trials against witches, Boston ministers suggested in a guilty, then those who confessed were less threaten- letter that caution be used with spectral evidence in- ing as they were returning to God from the Devil.6 terpretation and that no torture be used and warned None who confessed went to trial; however, of con- against accusations being shouted in court.3,7 In a cern was the state of the soul after a false confession. 1684 essay, noted six signs to dis- In a unique case, Giles Corey refused to plead to cern between medical illness and possession, includ- the indictment and was pressed to death by peine forte ing ability to speak and understand languages that et dure (French for hard and forceful punish- one should not know, knowledge of other people’s ment).3,21 Although rarely applied in the colonies, secrets, having superhuman strength, speaking with- English common law allowed for peine forte et dure, out using the lips, bodily inflexibility, and sudden the ultimate goal of which was forcing a person to inflation of the belly.10 plead rather than causing death.6 Persons were be- It was also considered impossible for a witch to lieved not to plead because they were either mute by recite the Lord’s Prayer perfectly. And perhaps some- visitation of God (imbecility or mental illness) or what surprisingly, considering the amount of time mute by malice (as with Mr. Corey). In order that

296 The Journal of the American Academy of Psychiatry and the Law Friedman and Howie justice not be cheated by those who refused to plead, the context of the thinking of the time, using inap- defendants who stood mute would have heavier and propriate sources, and failure to understand that con- heavier stones placed on their chests until they either fessions were often obtained under torture and coer- entered a plea or suffocated.22,23 The necessity for cion.9 Confessions were made to avoid execution, one to be fit to stand trial is believed to have arisen in rather than because of . Of those executed, English courts because of the practice of defendants there was no evidence of elevated rates of psychosis or standing mute,22 and thus peine forte et dure may .7,17 have been an early method of attempting to force The community legitimized the roles taken by the competency. girls, misguided professionals (clergy and doctors) helped, and those in authority willingly acqui- Medical and Psychiatric esced,3,8,20 a phenomenon that has been repeated Interpretations of Salem across time and place. A plausible and multifactorial The relatively recently proposed Ergot hypothesis interpretation has been that power, fear, malice, and put forward the possibility that, because of crop fail- incompetence allowed the events to transpire. Al- ure, there had been a food shortage and colonists ate though there has been an evolution of society’s con- ergotized rye, which led to convulsive ergotism ceptualization of witchcraft and supernatural phe- symptoms experienced by the accusing girls at Salem. nomena over time, the occurrences at Salem were not an isolated New England colonial experience. Arthur The ergot alkaloids would have grown in fungi on rye 26 flour and would have serotonergic and dopaminergic Miller’s Crucible, ostensibly about the Salem witch 24 trials, is an allegory and a cautionary tale regarding effects (similar to LSD). Ergotism, also known as 11 St. Anthony’s fire, included paresthesias, formica- 1950s McCarthyism. There are modern day paral- tion, and burning pain as well as convulsions. The lels at home and internationally. Ergot hypothesis was not substantiated by historical records, however.8 There was no food shortage. Fur- Modern Reassessment: Lessons for ther, often the only reported symptom in Salem was Forensic Psychiatry seeing apparitions, which are not a commonly de- In the modern era, false claims of victimization, scribed singular symptom of ergotism, especially such as the more recent daycare sexual abuse when hallucinations would be expected to be com- of the McMartin case from California to New Zea- bined with , , and convulsions.8 land’s Christchurch Civic Cre`che case and trials The eight girls did not experience residual symptoms brought about by so-called recovered memories have such as or weakness.24 Finally, the girls been likened to the Salem events.3,9,11,27–30 Exces- appeared able to turn their symptoms on and off.24 sive fear can distort perceptions of even simple To explain the girls’ accusations and behavior, phenomena. In any time period, human deviancy (malingering), can be misattributed, resulting in catastrophic errors (Mu¨nchausen’s), and , as well as of judgment. Concerns about child witnessing, the reaction formation, dissociation, and possession have certainty of physician diagnosis, and the use of spe- been put forward.4,5,7,10,11,15,19,20,25 Certainly, the cial evidence in the absence of study remain contem- sick role was reinforced, not only by sympathy but by porary problems. the tremendous amount of power that these formerly A modern re-examination of childhood testimony powerless girls were able to wield. Also, whether one from the Swedish witch hysteria of 1670 and 1671 that the girls purposefully took their roles or reviewed over 800 child testimonies from supposed did so through an unconscious psychological pro- child victims up to age 16. Stereotyped testimony cess, there is no disagreement about the trouble with correlated with age, gender, and social influence.31 giving up that role. It was not a sensible option to At the time, the courts considered whether the chil- state that one was never really afflicted; she would dren’s testimonies were “the result of satanic seduc- then herself face accusations of witchcraft.8 tions or the reflection of real events” (Ref. 32, p 66). Psychiatric interpretations of the witch hunts The test that priests had used for child testimony was (which have often suggested that those persecuted for whether the child was able to read certain or witchcraft were the mentally ill of the day) have been catechism.32 The modern caveat regarding child tes- criticized for failure to consider the occurrences in timony, related to lessons from the witchcraft trials,

Volume 41, Number 2, 2013 297 Salem Witchcraft and Lessons for Forensic Psychiatry is that such testimony is fraught with difficulties that continued to find the children repeating the false must be thoughtfully addressed. Safeguards do exist, allegations. This strongly suggested that one inter- however, in corroborative, noncoercive interviewing. view with reinforcement can lead to persistent false A balanced approach to protecting rights has to be allegations by the children.35 taken, rather than deductive certainty. Hood28 described a strikingly similar case, the In the 1983 McMartin preschool case, in Manhat- more recent New Zealand Christchurch Civic tan Beach, California, hidden underground tunnels, Cre`che case, as the product of a about airplane rides from the daycare, satanic worship childhood abuse and , for while dressed as witches, ritual sacrifice, drinking which another innocent individual was the scape- 33 blood, and eating of feces were all alleged. The case goat. The unreasonable fear was similarly reinforced occurred soon after the Vietnam conflict, the up- by what has been described as “largely untrained and heaval of the 1970s, and women’s entry into the unsupervised sexual abuse counselors who, imbued workplace. It began with a mother with schizophre- with their of authoritarian feminists, nia calling the police to say that her young son was pursued their mission of detecting child abuse with sodomized at daycare and progressed to the police’s zeal” (Ref. 29, paragraph 6). Although full psycho- sending letters to 200 families of current or former 11 logical analysis of these major daycare scandals is be- students. It led to panic at a national level, with the yond the scope of this article, they share with Salem FBI and Interpol investigating. The trial was the prominent features of moral panic, scapegoating, lengthiest and most expensive in American history, in- and suspension of disbelief. (For a fuller description of cluded the bizarre stories just described of ritual abuse of these cases, the interested reader is referred many children and yet did not result in a single con- 11,28,33 11,33 elsewhere. ) viction for any of the seven defendants. In retrospect, many asked how these cases could The McMartin case shared similarities with long appear to take on a life of their own. Showalter30 ago Salem: fantastical child testimony mirroring the described a hysterical triangle, including a physician beliefs of the time by suggestible children, interviews enthusiast (such as Dr. Griggs in Salem and the Mc- with leading questions, and the idea that innocent Martin interviewers); a disillusioned, vulnerable pa- children cannot lie.33 In videotaped interrogations of the children, examiners promised rewards and asked tient; and a cultural environment that is supportive. leading questions.11 Battling concerns about modern Showalter noted that “Hysteria needs a doctor or day competence in child interviewing, recent schol- theorist, an authority figure who can give it a com- arship has focused on appropriate interview tech- pelling name and narrative” (Ref. 30, p 19). Experts niques. Subsequent studies have investigated the uti- must exercise due caution in interviews and diagno- lization of child interviewing techniques specifically sis, and strive for objectivity, being aware of potential by examining transcripts of the McMartin case. In biases and temptation toward being an advocate for one study, techniques used by the McMartin inter- alleged victims. As noted earlier, concerns about phy- viewers were more effective than simple suggestive sician certainty and the use of special evidence in the questions at inducing preschool children to make absence of study also remain relevant today. Physi- false allegations against a classroom visitor.34 Sugges- cian certainty about diagnosis, as was the case with tive questions, when combined with social influence Dr. Griggs in Salem, who diagnosed witchcraft after and reinforcement, led to more false accusations in a he had ruled out epilepsy, and such as the preconcep- sample of preschool children questioned after their tions about abuse in evaluators in the daycare cases, is classroom had a visitor.34 Another study used two addressed by speaking in court on the balance of specific components of the McMartin interviews, re- probabilities or with reasonable medical certainty. inforcement and co-witness information, in inter- Evaluators must also use caution to not enter exam- views of children ages 5 to 7. Reinforcement in- inations with presumptions or bias. The use of spe- creased false allegations against a classroom visitor cial evidence (in Salem, claims of seeing specters and threefold. Especially when being asked about events witches’ ) is protected against currently by considered fantastic such as leaving the school on a Daubert criteria for scientific evidence.36 However, helicopter, false allegations increased with reinforce- as a profession, forensic psychiatrists must remain on ment. A second interview without reinforcement guard and apply the Daubert criteria, such as general

298 The Journal of the American Academy of Psychiatry and the Law Friedman and Howie acceptance and peer review, in an age of an increasing 13. Goodheart LB: The distinction between witchcraft and madness in colonial Connecticut. Hist Psychiatry 13:433–44, 2002 number of journals of various qualities. 14. McDonald SW, Thom A, Thom A: The Bargarran witchcraft trial: a psychiatric reassessment. Scot Med J 41:152–8, 1996 Conclusions 15. Hill F: A Delusion of Satan: The Full Story of the . New York: Doubleday, 1995 Those who cannot remember the past are condemned to 16. Boyer P, Nissenbaum S: Salem Possessed: The Social Origins of 37 repeat it.—George Santayana Witchcraft. New York: MJF Books, 1974 17. Schoeneman TJ: The role of mental illness in the European witch Factors brewing in Salem have occurred elsewhere hunts of the sixteenth and seventeenth centuries: an assessment. J in time and place. Malice and incompetence, pro- Hist Behav Sci 13:337–51, 1977 jected onto bad circumstances and complete confi- 18. Flotte TJ, Bell DA: Role of skin lesions in the Salem witchcraft trials. Am J Dermatopathol 11:582–7, 1989 dence by key players that they were right are certainly 19. Starkey ML: The Devil in Massachusetts. New York: Random not unique to Salem. Malice included greed, settling House, 1949 scores, and scapegoating in Salem and, in the daycare 20. Geis G, Bunn I: A Trial of Witches. Routledge: London, 1997 scandals, included homophobia, xenophobia, and 21. Greek C: Drug control and asset seizures: a review of the history of forfeiture in England and colonial America, in Drugs, Crime and scapegoating. Incompetence in Salem included reli- Social Policy. Edited by Mieczkowski T. Boston: Allyn and Ba- ance on flawed testimony, medical determinations of con, 1991, pp 109–37 witchcraft, and theological explanations of natural 22. Mossman D, Noffsinger SG, Ash P, et al: AAPL Practice Guide- line for the Forensic Psychiatric Evaluation of Competence to justice, whereas in the daycare scandals, it similarly Stand Trial. J Am Acad Psychiatry Law 35(Suppl 4):S3–S72, included reliance on problematic eliciting of chil- 2007 dren’s testimony. Finally, bad circumstances (isola- 23. Schwalbe E, Medalia A: Cognitive dysfunction and competency restoration: using cognitive remediation to help restore the unre- tion and inconstant rule of law in Salem or commu- storable. J Am Acad Psychiatry Law 35:518–25, 2007 nity fears about putting children in daycare when 24. Woolf A: Witchcraft or mycotoxin?—the Salem witch trials. J women were entering the workforce in large num- Toxicol Clin Toxicol 38:457–60, 2000 bers) stirred the pot. Lessons for forensic psychiatry 25. Gevitz N: ‘The devil hath laughed at the physicians’: witchcraft and medical practice in seventeenth-century New England. J Hist involve not only understanding the larger factors in- Med Allied Sci 55:5–36,2000 volved in society’s fears, but also cautions regarding 26. Miller A: The Crucible. London: Penguin Classics, 2003 eliciting child testimony, certainty of physician diag- 27. Gardner RA: Sex Abuse Hysteria: Salem Witch Trials Revisited. Cresskill, NJ: Creative Therapeutics, 1990 nosis, use of special evidence, and tautological 28. Hood L: A City Possessed: The Christchurch Civic Creche Case. reasoning. Dunedin, New Zealand: Longacre Press, 2001 29. Ministry of Justice Report on A City Possessed: Lynley Hood’s Book on the Christchurch Civic Creche Case. Available at http:// References www.peterellis.org.nz/2002/2002-0521_MinistryJustice_ValSim- 1. The Holy : King James Version. Dallas: Brown Books Pub- ReportOnHoodsBook.htm. Accessed March 15, 2013 lishing, 2004 30. Showalter E: Hystories. New York: Columbia University Press, 2. Kemp S, Williams K: and in 1997 medieval and early modern Europe. 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